126) Answer

B. A systolic murmur heard over the left sternal border

Rationale

•A typical systolic ejection murmur heard loudest at the upper left strenal border is indicative of pulmonic stenosis. A thrill may be present in the upper left sternal area or at the suprasternal notch.

•Pulmonary stenosis is the narrowing of the pulmonary valve or the pulmonary artery just distal to the valve. Inability of the right ventricle to evacuate blood may lead to right ventricular hypertrophy.

•Most patients with pulmonary stenosis are asymptomatic. Severe stenosis can cause exertional angina, syncope, or sudden death.

•Exertional dyspnea is more often associated with severe aortic stenosis or tetralogy of Fallot.

•Thrills are felt, not heard.

•Cyanosis does not usually occur with only pulmonic stenosis.